Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure

Bocchialini, Gabriele; Ambrosi, Serena; Castellani, A.

doi:10.1155/2017/7016467

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…The supra-hyoid spaces are contiguous with infra-hyoid spaces, notably the parapharyngeal and retropharyngeal spaces, which can lead to the mediastinal compartment. Different procedures have been associated with cervicofacial emphysema, ranging from endodental treatment to teeth extractions, even hygiene procedures [42]. Use of air syringes, or more frequently air-driven dental handpieces, which inject air at high pressure, are prominent risk factors [3].…”

Section: Discussionmentioning

confidence: 99%

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Busuladzic

Patry

Fradet

et al. 2020

J of Otolaryngol - Head & Neck Surg

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Background: Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. Case presentation: We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces. Conclusion: As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.

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Section: Discussionmentioning

confidence: 99%

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Busuladzic

Patry

Fradet

et al. 2020

J of Otolaryngol - Head & Neck Surg

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“…In most cases, subcutaneous emphysema and/or pneumomediastinum are benign and self-limiting 29) . These cases need observation with prophylactic antibiotics to prevent secondary infections caused by the introduced bacteria 8,16) .…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Electric Handpiece-related Pneumomediastinum and Cervicofacial Subcutaneous Emphysema in Third Molar Surgery

Ohta

Yoshimura

Ryoke

et al. 2019

J. Hard Tissue Biology.

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Pneumomediastinum and/or cervicofacial subcutaneous emphysema are extremely rare but severe complications in third molar surgery. The most common cause is compressed air exhaust from an air-driven high-speed handpiece. To prevent these complications, treatment with an electric handpiece that does not use the drive air is generally recommended; however, its safety has not been fully verified. In this study, we investigated electric handpiece-related emphysema during third molar surgery. We evaluated patients who visited our hospital in relation to third molar surgery between January 2008 and December 2017. Of the 2938 patients examined, 2 patients were complicated with electric handpiece-related pneumomediastinum and cervicofacial subcutaneous emphysema during sectioning the mandibular third molar. In these cases, a straight motor handpiece and a 1:5 speed increasing contra-angle motor handpiece were used, respectively. Both patients received antibiotics and follow-up examination under hospitalization. Although the air flow and pressure of an electric handpiece are lower than those for air-driven high-speed handpieces, the air expelled from electric handpieces could cause cervicofacial emphysema and/or pneumomediastinum. It should be noted that electric handpieces do not use the drive air; however, most of these handpieces have air/water nozzles and use tip air. Before treatment, an informed consent to patients about the risk of emphysema is mandatory. With regard to the surgical technique, elevation of the mucoperiosteal flap should be minimal. Attention should be also paid to the possibility that the air inflow route is made through removal or perforation of the cortical bone. To prevent emphysema, an electric surgical handpiece with an external water spray may be preferable for removing the bone and cutting the tooth, because this type of surgical handpiece has a separate water drip for cooling instead of combined water and air spray, and it does not use the flux of air.

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“…In 2018, Lee et al reported only nine cases, including their own, associated with the use of air-powder abrasive devices; however, to the best of our knowledge fourteen cases of CSE due to the use of air-flow in twelve articles have been reported in the literature to date. 6,[8][9][10][11][12][13][14][15][16][17] Therefore, here we report the fifteenth case. Interestingly, all reported cases consisted of non-surgical periodontal procedures such as implant and dental cleaning procedures or non-surgical peri-implantitis treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Six of the previously reported cases were associated with pnemomediastinum, no pneumothorax or airembolism were reported in any of these cases. 7,11,12,14,16,17 Only one case of implant-cleaning related emphysema progressed to mild pneumothorax. 8 We found a pneumomediastinum without pneumothorax and air-embolism.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An Unusual Complication of Periodontal Debridement: Subcutaneous Emphysema and Pneumomediastinum

Açikgöz¹,

Açıkgöz²,

Karaduman³

et al. 2019

Turkiye Klinikleri J Case Rep

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Massive Cervicothoracic Subcutaneous Emphysema and Pneumomediastinum Developing during a Dental Hygiene Procedure

Cited by 13 publications

References 20 publications

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Cervicofacial and mediastinal emphysema following minor dental procedure: a case report and review of the literature

Investigation of the Electric Handpiece-related Pneumomediastinum and Cervicofacial Subcutaneous Emphysema in Third Molar Surgery

An Unusual Complication of Periodontal Debridement: Subcutaneous Emphysema and Pneumomediastinum

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